Acute Bacterial Rhinosinusitis Clinical Pathway – Primary Care, Emergency Department and Inpatient

History and Physical

ABRS can be very difficult to distinguish from viral rhinitis, particularly sequential viral illnesses in younger children. The following findings in isolation do not differentiate a viral from a bacterial etiology of rhinosinusitis and are not diagnostic of ABRS:

Purulent or colored nasal discharge
Sinus/facial pressure or tenderness to palpation

History	Duration of symptoms
Physical	Temperature ≥ 39°C Nasal drainage Transillumination of the sinuses is not recommended in diagnosing ABRS

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.